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343 Cards in this Set
- Front
- Back
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List behaviors assoc with a trusting relationship
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caring, openness, objectivity, respect, interest, understanding, consistency, treating the client as a human being, suggesting without telling, approachability, listening, keeping promises, honesty
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list components of a therapeutic relationship
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trust, genuine interest, empathy, acceptance, positive regard, self awareness and therapeutic use of self
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what is the difference between empathy and sympathy
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empathy is the ability of the nurse to perceive the meaning and feelings of the client and to communicate that understanding to the client; sympathy = feelings of concern or compassion one shows for another
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what is congruence
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when words and actions match
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how do we convey acceptance of clients
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avoid judgements, setting boundaries without anger
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what is positive regard
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appreciating each client as a unique worthwhile individual and respecting the client regardless of his/her behavior, background or lifestyle; unconditional, nonjudgemental attitude
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self awareness
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process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, prejudices, strengths and limitations and how these qualities affect others
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values
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abstract standards that give a person a sense of right and wrong and establish a code of conduct for living
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what is the values clarification process and how is it used
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choosing, prizing, acting; person freely chooses value that feels right, publicly attaches the value to themselves and puts it into action; used to gain insight into oneself and personal values
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beliefs
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ideas that one holds to be true
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attitudes
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general feelings or a frame of reference around which a person organizes knowledge about the world
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therapeutic use of self
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use aspects of personality, experiences, values, feeling, intelligence, needs, coping skiils and perceptions to establish relationships with clients
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preconceptions
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ways one person expects another to speak or behave; roadblock to formation of authentic relationship
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four patterns of knowing
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empirical (derived from science of nursing); personal (derived from life experiences); ethical (derived from moral knowledge of nursing); aesthetic (derived from the art of nursing)
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unknowing
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nurse admitting they do not know the client or the clien'ts subjective world; opens up for truly authentic encounter
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how are four patterns of knowing used
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provide nurse with a clear method of observing and understanding every client interaction
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types of relationships
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social, intimate, therapeutic
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social relationship
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primarily initiated for the purpose of friendship, socialization, companionship or accomplishment of task; responsibility belongs to both parties
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intimate relationship
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two people who are emotionally committed to each other; no place in nurse-client interaction
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therapeutic relationship
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focuses on needs, experiences, feelings and ideas of the client ONLY; nurse has the responsibility for this relationship
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phases of a therapeutic relationship
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orientation, working, termination
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what happens during orientation phase of therapeutic relationship
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meet, establish roles, purpose and parameter of future meetings discussed, clarify expectations, identify pt's problems, nurse gathers data, contracts, confidentiality, duty to warn, self disclosure
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describe the working phase of the therapeutic relationship
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problem identification, examination of feelings/responses, development of better coping skills, more positive self image, behavior change, independence
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when does the termination/resolution phase of therapeutic relationship begin
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when pt's problems are resolved
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what are some behaviors that diminish therapeutic relationships
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inappropriate boundaries, feelings of sympathy, encouraging pt dependency, nonacceptance of pt as person bc of his/her behaviors leading to avoidance
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how do we avoid behaviors that diminish therapeutic relationships
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nurse self awareness
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roles of the nurse in a therapeutic relationship
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teacher, caregiver, advocate, parent surrogate (not necessarily a good role)
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verbal communication
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the words a person uses to speak to one or more listeners
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nonverbal communication
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behavior that accompanies verbal content
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content
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literal words a person speaks
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context
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environment in which the communication occurs
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congruent message
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when process and content agree
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process
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all nonverbal messages that the speaker uses to give context and meaning to the message
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incongruent message
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when content and process disagree
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therapeutic communication
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interpersonal interaction bw nurse and client during which nurse focuses on client's specific needs to promote an effective exchange of information
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goals of therapeutic communication
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establish therapeutic relationship, identify pt's most important concerns, assess perceptions, facilitate expression of emotions, teach necessary self care skills, guide pt toward acceptable solutions
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proxemics
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study of distance zones bw people during communication
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intimate zone
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0-18 inches
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personal zone
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18-36 inches
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social zone
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4-12 ft
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public zone
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12-25 ft
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at what range of space is therapeutic communication most comfortable
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3-6 ft
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examples of therapeutic communication techniques
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silence, active listening, observing, clarifying techniques, asking questions and eliciting patient responses
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examples of non therapeutic communication techniques
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excessive questioning, giving approval or disapproval, giving advice, asking why questions, giving false assurances, reinforcing hallucinations or delusions
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how can we respond to hallucinations
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say I know you can see it, but I can't
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how can we respond to delusions
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we voice doubt, ask why
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overt cues
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clear, direct statements of intent
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covert cues
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vage or indirect messages that need interpretation and exploration
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cultural considerations
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speech patterns and habits, styles of speech and expression, eye contact, touch, concept of time, health and health care
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skills used in non verbal communication
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facial expression, body language, vocal cues, eye contact, silence
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goals when beginning therapeutic communication
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introduce and establish a contract, find pt centered goals, use directive or nondirective role as needed, phrase questions appropriately, guide pt in problem solving and empower pt to change, alert for inappropriate responses by nurse
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nondirective role
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nurse acts as a guide, pt will generally identify the problem they want to discuss
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directive role
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asking direct yes/no questions and using problem solving to help the client develop new coping mechanisms to deal with present issues
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thought process
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how patient thinks
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thought content
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what pt actually says
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delusions
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false, fixed ideas
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thought blocking
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stop abruptly and unable to continue talking about subject
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ideas of reference
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they feel that events are directed at them
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thought broadcasting
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they think others can hear or know what their thoughts are
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thought insertion
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think others are putting thoughts into their head
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thought withdrawal
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think thoughts are being taken out of their head
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word salads
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different words with no connection
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flight of ideas
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rapidly jumping from one subject to another; common in manics
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circumstantial thinking
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eventually give an answer but only after a lot of unnecessary details
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tangential thinking
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they talk around the subject
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how do toddlers communicate with adults
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pull things to them, push things away, point, try to cover mouth
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when is consent for postmortem exam not needed
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unexplained deaths, violent deaths, suicides
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who is responsible for obtaining the informed consent
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person performing procedure
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what is the nurse's role in informed consent
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patient advocate, witness the signature on the consent form
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how many witnesses for verbal or telephone consent
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two
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when parents are divorced who gives informed consent
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parent with legal custody
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conditions where minors are considered medically emancipated
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STD, alcohol and drug abuse, contraceptives
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what is a very common symptom of acute childhood illness
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loss of appetite
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how should we handle loss of appetite in kids?
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not forcing foods (will exacerbate the problem); let them eat what they will
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what position should child be in when gavage feeding
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elevated head, right side or hold
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how much do we administer when gavage feeding
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5mL every 5-10 mins for premature and very small infants; 10 mL every 5-10 mins for older infants and children
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after gavage feeding how should pt be positioned
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on right side for 1 hr
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what type of gastric tube should we use for neonates and why
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orogastric bc they are nose breathers
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what is the gold standard for determining g tube placement in children
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x ray
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what is a gastrostomy tube
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used when feeding is required over an extended period of time; directly into stomach through abdomen
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after feeding with gastrostomy, how is tube positioned
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clamped or left open and suspended
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why do we suspend gastrostomy tubes
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so air can escape the belly
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what is the difference between a gastrostomy button and tube
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button is fully immersible inwater, increased comfort and mobility, button has a one way valve at one end, must attach extension tubing for feeding
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how do we prepare extension tubing for a gastrostomy button
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fill with fluid BEFORE you attach it or you will put that much air into the stomach
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1 gm of wet diaper = ? Urine
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1 mL
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how do we determine urine output with diaper
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subtract weight of dry diaper from weight of wet diaper
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what is a minimum acceptable output for infants
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1.0 mL/kg/hr or greater
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what is a minimum acceptable output for children
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0.5 mL/kg/hr or greater
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what is the best time to get a urine specimen
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first AM specimen
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how is a cotton ball used to get a urine sample
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put in diaper; when child urinates, will soak up urine; squeeze into sample container
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when is suprapubic aspiration used
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when bladder cannot be accessed through the urethra
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what has reduced the need for suprapubic aspiration
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small catheter sizes (5 and 6 french)
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what kind (tonic) of enemas are used for children
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isotonic
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what types of enemas do we use with children
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prepared saline, milk and molasses, 1 tsp of salt with 1 pint of tap water
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why do we not use tap water enemas on children
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is hypotonic which can lead to fluid overload
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after administering the enema, how do we assist the child
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hold their buttocks together for short time
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what products are hospitals turning to instead of enemas
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golytely and nulytely orally or through NGT
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why would an infant not have a colostomy pouch
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they wear a diaper and it can be irritating to sensitive skin
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why should we always use a pouch with ileostomies
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secretions are caustic to skin
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what causes diaper dermatitis
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prolonged and repetitive contact with an irritant or combination of irritants
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what does candida albicans diaper dermatitis look like
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bright red scaly plaques; satellite lesions; maybe papules and pustules; affects skin folds
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how does oral candidiasis present
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white patches on the tongue, palate, and inner aspects of the cheeks that do not scrape off
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how do we treat diaper dermatitis
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barrier cream, hydrocortisone cream
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how do we treat diaper candidiasis
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antifungal cream plus barrier cream
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how can we prevent diaper dermatitis
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use superabsorbent diapers, change as soon as soiled, expose skin to air, barrier cream to protect skin
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how do we treat oral candidiasis
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nystatin (swish, swab, swallow) 4X per day
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how do we prevent oral candidiasis
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boil reusable nipples and bottles for 20 mins after thorough washing; boil pacifiers at least 20 mins every day; treat infant and mom if breastfeeding
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what % of the infant's ECF is water?
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40% (adult 20%)
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why are infants and young children more vulnerable to alterations in fluid and electrolyte balance
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immature kidneys are inefficient in concentrating and diluting uring
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what are the maintenance fluid requirements for children
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first 10kg of weight = 100 ml/kg; second 10kg of weight = 50ml/kg; remaining kg of weight=20ml/kg
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how do we determine the rate for maintenance fluid for children
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requirements divided by 24 hours
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how do we replace fluid lost through suction
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measure the volume and divide by number of hours ordered to replace over; add answer to baseline IV rate for prescribed number of hours
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what are things we can assess to determine fluid balance?
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fontanel, skin turgor, lips, mucous membranes, urine specific gravity, lung sounds, mental status, edema, capillary refill, weight
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how do children's heart rates change as they get older
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very fast when little, begins to decrease as they hit toddler and child ages
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in what order should we cheeck vital signs with kids and why
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respirations first, heart rate second, bp and temp last; least invasive to most invasive; more likely to cooperate
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how long do we count respirations and why
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1 full minute bc children naturally have irregular breathing
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what do we watch to count children's respirations
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abdomen; they tend to breathe more with their diaphragm than their chest muscles
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where do we assess children's heart rate
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apical until about 7 yrs; can assess radials after 2
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how long do we count heart rate and why
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1 full minute bc children naturally have irregular heart rate
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if your bp cuff is too big or too small how does it affect your reading
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too big=lower bp; too small=higher reading
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the cuff bladder should cover ? Of arm circumference
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80-100%
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where are most bp measurements done on children
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leg
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how does leg bp compare to arm bp
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leg will be higher
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what type of thermometer is recommended for birth to 1 month
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axillary
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when is an axillary thermometer contraindicated and why
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in anyone critically ill bc it may not be as sensitive to early changes in temp
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how does a temporal artery thermometer work
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measures heat from arterial blood flow
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when do we start using temporal artery thermometers on children
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over 3 months of age
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which type of temp has been shown to be the closest to the core temp
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temporal artery thermometer
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who should we not use an oral thermometer on
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mouthbreather, oral surgery, comatose, seizure prone, recent drinking/eating
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how far should a rectal thermometer be inserted
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1 inch for children, 0.6 inch for infants
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fever is an elevation in ?
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set point
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what body part is our natural thermostat
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hypothalamus
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what two meds are generally used in infants and children for fever intervention
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motrin, tylenol
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how do we dose motrin for children
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5-10 mg/kg/dose every 6-8 hrs, max 40 mg/kg/day
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how do we dose tylenol for children
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10-15 mg/kg/dose every 4-6 hours, max 5 doses per day
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when is a fever a "bad" fever
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less than 3 months (immature immune system), underlying conditions, prone to febrile seizures; fever greater than 24 hours, 104-105; more than 3 days, had for 24 hrs, went away and came back
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what is the most common seizure of childhood
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febrile seizures
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what about a febrile seizure causes the actual seizure
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the rapid rise, NOT the fever itself
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how do we measure infants
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recumbent length; birth to 2 years
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how do we weight infants
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nude if less than 3 years; toddlers can be weighed with diaper
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where do we measure the head circumference
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above eyebrows and ears, at occiput; at greatest circumference
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where do we measure chest circumference
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at nipple line with inspiration and expiration, average
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where do we measure abdomen circumference
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at umbilicus
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how do we measure abdominal circumference around a hernia
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document if measured above or below
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when does the anterior fontanel close
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12-18 months
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when does the posterior fontanel close
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2 months
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what are brushfield spots and what can they indicate
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white speckles in iris; common in down syndrome
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when does eye color develop
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6-12 months
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absence of the red reflex in children can indicate what
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retinal blastoma
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when do infants fix on objects
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1 month
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what do infants see at 3-4 months
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two images, like unfocused binoculars
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when do infants start to see one image of everything
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by 4 months
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what causes strabismus
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muscle imbalance
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if strabismus is not treated what develops
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amblyopia (lazy eye)
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low set ears can indicate ?
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downs, renal disease, or genetic defect
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how do we position ear when taking temp
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less than 3 yrs, down and back; older than 3 yrs, up and back
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nasal flaring and head bobbing can indicate
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resp distress
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what is stridor
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high pitched sound in lungs, usually indication of airway narrowing
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what does grunting indicate
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trying to pop airways open, increases pressure in the airway, sign of resp distress
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children need ? Oxygen
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warm
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how can we estimate the size of ET tube needed
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look at pinky finger
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when suctioning a child what is NOT recommended
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normal saline irrigation
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when is a chest tube indicated
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pneumothorax, hemothorax, post op thoracic or cardiac surgery, pleural effusion
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what should the water seal on a chest tube look like
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should rise and fall but not actively bubble
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keep chest tube system ? Than pt chest
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lower
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if a chest tube falls out what do we do
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cover with 3 sided dressing
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denver II developmental screening identifies what
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if developmental level is normal or below normal for age
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what is SASH
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protocol for INT; saline, antiobiotic or other med, saline, heparin
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when doing a finger or heel stick what can we do first to help blood flow
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warm, moist compress 5-10 mins before blood draw
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milking during blood draws can result in
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elevated potassium levels
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what part of the finger do we stick
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side of finger pad
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how do we determine where to do a heel stick
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draw imaginary line down foot and parallel to side of foot starting at middle of great toe and between last two toes on foot; puncture on lower outer part of foot
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what size syringe do we use when aspirating blood from a central line
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no smaller than 10mL
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what is the max volume for an IM admin on children
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1/2 mL for babies; 1 mL for children (up to 2mL); infant doses may need to be divided
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what is the most popular site to give IM on children
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vastus lateralis
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blood should be infused in what time frame
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less than 4 hours
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list some guidelines when communicating with children
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allow time to feel comfortable, avoid sudden advances, talk to parent if shy, communicate through transition objects, give older child opportunity to communicate w/o parents, eye level, use short words and sentences, offer a choice only when one exists, honesty, allow them to express fears/concerns
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list some guidelines when communicating with adolescents
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spend time together, encourage expression, respect views, tolerate differences, praise good points, respect privacy, set good example, undivided attention, LISTEN, avoid judging/criticizing
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five critical factors in the process of labor and birth
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birth passage, fetus, relationship bw passage and fetus, physiologic forces of labor, psychosocial considerations
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the birth passage consists of
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bony pelvis and soft tissues
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4 types of pelvises
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gynecoid, android, anthropoid, platypelloid
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gynecoid pelvis
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most common, female, favorable
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android pelvis
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male, usually not adequate
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anthropoid pelvis
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narrow from side to side, usually adequate
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platypelloid pelvis
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narrow from back to back, usually NOT adequate
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aspects and position of fetal body critical to the outcome of labor
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fetal head, fetal attitude, fetal lie
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least compressible and largest part of fetus
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fetal head
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molding
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overlapping of bones during birth
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fontanelles
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intersections of sutures
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sutures
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membranous spaces between cranial bones
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how are fontanelles useful during vaginal exam
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help determine position of baby
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4 sutures of fetal skull
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frontal (mitotic), sagittal, coronal, lambdoidal
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frontal suture
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located bw two frontal bones, becomes anterior continuation of sagittal suture
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sagittal suture
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located bw parietal bones, divides skull into right and left halves, connects two fontanelles
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coronal suture
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located bw frontal and parietal bones, extends transversely left and right from anterior fontanelle
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lambdoidal suture
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located bw two parietal bones and occipital bone, extends transversely from posterior fontanelle
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along with the sutures, what other landmarks are useful in determining position of baby
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anterior and posterior fontanelles
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what is the purpose of the anterior fontanelle
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permits growth of brain by remaining unossified for as long as 18 months
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when does the posterior fontanelle close
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within 8-12 weeks after birth
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list the 6 landmarks of the fetal skull
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mentum, sinciput, bregma, vertex, posterior fontanelle, occiput
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mentum
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fetal chin
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sinciput
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brow
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bregma
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anterior fontanelle
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vertex
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area bw anterior and posterior fontanelle
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occiput
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occipital bone
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what is the biparietal diameter
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major transverse diameter, largest part of head
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fetal attitude
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position of the fetus, arms, knees, head generally flexed in
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fetal lie
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position of fetus compared to mother; can be longitudinal or transvers
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fetal presentation
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determined by fetal lie and by the body part of the fetus that enters the pelvic passage first
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types of fetal presentation
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cephalic, breech, shoulder
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types of cephalic presentation
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vertex, military, brow, face
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types of breech presentation
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complete, frank, footling
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vertex presentation
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most common, occiput is presenting part
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military presentation
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head is in neutral position, top of head is presenting part
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brow presentation
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head partially extended, brow is presenting part
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face presentation
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head hyperextended, face is presenting part
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what is the most favorable presentation
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vertex
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complete breech
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both knees are flexed
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frank breech
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buttocks present to pelvis
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footling breech
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on or both feet present to pelvis
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a shoulder presentation is also known as
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transverse lie
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what do we do with a transverse lie
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external version (try to turn baby), c section, monitor FHR at all times
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engagement
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presenting part that occurs when the largest diameter of the presenting part reaches or passes through the pelvic inlet
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when does engagement occur with primigravidas
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generally two weeks before term
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when does engagment occur with multigravidas
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several weeks before or at onset of labor
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station
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relationship of presenting part to an imaginary line drawn at ischial spines
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zero station
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at level of ischial spines
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negative station
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above ischial spines
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positive station
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below ischial spines
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station is measured in what unit
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cm
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fetal position
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relationship of the landmark on the presenting part to the maternal pelvis
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which fetal positions are considered normal
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ROA, LOA
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what is the primary force of labor
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uterine contractions
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what is the secondary force of labor
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abdominal muscles
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terms used to describe contractions
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increment, acme, decrement, frequency, duration, intensity
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increment phase of contraction
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building up of the contraction, longest phase
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acme phase of contraction
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peak of the contraction
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decrement phase of contraction
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letting up of the contraction
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frequency of contraction
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time between beginning of one contraction and beginning of next contraction
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duration of contraction
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measured from beginning of contraction to completion of same contraction
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intensity of contraction
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refers to strength of contraction during acme; judged mild, moderate or strong
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you should measure at least ? Cycles before you decide on frequency, etc
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3 cycles
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bearing down, or pushing, should wait until ___ bc it can cause _____ if done too soon
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should wait until cervix is completely dilated or pushing can cause cervical edema (which retards dilatation), tearing and bruising of cervix and maternal exhaustion
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effacement
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drawing up of the internal os and the cervical canal into the uterine side walls; cervic changes progressively from long, thick structure to tissue paper thin
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hormones involved in the cause of labor
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progesterone, estrogen, oxytocin, prostaglandins, fetal cortisol, corticotropic releasing hormone
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premonitory signs of labor
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lightening, braxton hicks, cervical changes, bloody show, rupture of membranes, sudden burst of energy
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describe lightening
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effects that occur when the fetus begins to settle into the pelvic inlet (engagement)
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braxton hicks contractions
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irregular, intermittent contractions that occur throughout pregnancy
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cervical changes that occur just prior to onsest of labor
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ripening (softening of cervix)
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what is a bloody show
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mucous plug of cervix is exprelled, resulting in small amount of blood loss from exposed cervical capillaries; sign that labor will begin within 24-48 hours
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what is the sign that indicates true labor as opposed to false
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cervical changes
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characteristics of true labor
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regular contractions, cervical changes, contractions start in back and radiate around to abdomen, pain not relieved with activity
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characteristics of false labor
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irregular contractions, no cervical changes, contractions primarily in the abdomen, pain may be relieved with activity
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4 stages of labor
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effacement and dilatation, maternal pushing, delivery of placenta, recovery
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3 phases of stage 1 of labor
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latent, active, transition
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latent phase of labor
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starts with beginning of regular contractions, dilation of 0-3cm
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active phase of labor
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dilation of 4-7cm, fetal descent is progressive, contractions become more frequent and longer in duration, increase in intensity
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transition phase of labor
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dilation of 8-10 cm; contractions very frequent, enduring and strong intensity
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stage 2, maternal pushing, of labor
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begins with complete cervical dilation, ends with birth of baby
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crowning
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fetal head is encircled by external opening of vagina (introitus), means birth is imminent
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cardinal movements
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mechanisms of labor; fetal head and body adjust to passage by certain positional changes
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7 cardinal movements
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descent, flexion, internal rotation, extension, restitution, external rotation, expulsion
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descent
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head enters inlet in occiput transverse or oblique position
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flexion
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fetal head descends and meets resistance from soft tissues of pelvis; fetal chin flexes downward onto the chest
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internal rotation
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fetal head must rotate to fit diameter of pelvis cavity
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extension
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extension of the fetal head as it passes under symphysis pubis
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restitution
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once head is born, neck untwists, turning head to one side and aligns with position of the back
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external rotation
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as shoulders rotate to anteroposterior position in pelvis, head turns farther to one side
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expulsion
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anterior shoulder is born before posterior shoulder; body follows shoulders quickly
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a placenta is considered retained after ? Mins
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30 mins
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shiny schultze
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when placenta is delivered inside out
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dirty duncan
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when placenta is delivered with maternal side out
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when the placenta separates we will see
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rise in fundus in abdomen, sudden gush of blood, further protrusion of umbilical cord
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the recovery stage usually lasts
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1-4 hours
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the recovery stage is characterized by
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decreased bp, fatigue, thirst, hunger, hypotonic bladder, hemodynamic changes, the fundus is bw the symphysis and umbilicus
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maternal cardiovascular responses to labor
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increased cardiac output, increased BP
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which position lowers cardiac output
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supine
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which position increases bp during labor
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left lateral
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respiratory response to labor
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increased o2 demand, hyperventilation may occur, pushing increases lactate levels
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renal response to labor
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increased maternal renin, plasma renin, angiotension, trauma to bladder; blood and lymph drainage impaired from presenting part
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GI responses to labor
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gastric motility and absorption decreased; emptying time increased; risk of aspiration with general anesthesia; glucose levels decreased
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WBC count increases during labor to what
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25K to 30K due to stress response
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when should pregnant women come to the hospital
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rupture of membranes; regular, infrequent uterine contractions; any vaginal bleeding; decreased fetal movement
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mild contractions are similar to the consistency of
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the tip of the nose
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moderate contractions feel like what part of your face
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the chin
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strong contractions resemble the indentability of your ?
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forehead
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what is leopolds maneuver
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systematic way to evaluate woman's abdomen to determine fetal position and presentation
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leopolds maneuver may be difficult to perform when
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woman is obese or has excessive amniotic fluid
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1st step of leopolds
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face woman, palpate upper abdomen with both hands, determine whether head or buttocks occupies fundus;
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2nd step of leopolds
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try to determine location of fetal back by palpating sides of abdomen with gentle but deep pressure; hold right hand steady while left hand palpates, vice versa;
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3rd step of leopolds
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3rd) gently grasp abdomen with thumb and fingers just above symphysis pubis, determine if head or buttocks and whether engaged;
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4th step of leopolds
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4th) face womans feet; place hands on lower abdomen and move down sides of uterus towards pubis; locate brow
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besides leopolds maneuver, what other two options are used to determine fetal position
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vaginal exam and ultrasound
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where is the fetal heart rate most clearly heard
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at the fetal back
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if fetus is in cephalic position where will FHR be located
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lower quadrants
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if fetus is in breech position where will FHR be located
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upper quadrants
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if fetus is in transverse lie where will FHR be located
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near umbilicus
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indications for electronic fetal heart rate monitoring
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previous hx of stillbirth 38 weeks or more; presence of pregnancy complication; induction of labor; preterm labor; decreased fetal movement; nonreassuring fetal status; meconium staining of amniotic fluid; trial of labor following c section; maternal fever; placental problems
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what is used for external monitoring of FHR
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ultrasound; sometimes telemetry
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device used for internal monitoring of FHR
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fetal scalp electrode
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what two parts of the fetus can we put the FHR electrode on
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buttocks, occiput
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normal range for FHR baseline
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110-160
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accelerations of FHR are caused by
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fetal movement
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describe early decelerations of FHR
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onset occurs before onset of contraction; uniform in shape; caused from fetal head compression; does not require intervention
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describe late decelerations of FHR
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onset occurs after onset of contraction; uniform in shape; caused from uteroplacental insufficiency; nonreassuring but does not necessarily require immediate delivery
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describe variable decelerations of FHR
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onset varies with timing and onset of contraction; variable in shape; caused from umbilical cord compression; requires further assessment
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immediate postbirth danger signs
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hypotension, tachycardia, uterine atony, excessive bleeding, hematoma
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describe apgar scoring
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used to evaluate physical condition of newborn at birth; rated 1 min after birth and again at 5 mins; score ranges from 0-10
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when should apgar scoring be repeated
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if score is less than 7 at 5 mins; repeat every 5 mins for up to 20 mins
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what 5 things are evaluated with apgar scoring
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heart rate, respiratory effort, muscle tone, reflex irritability, color
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what apgar score indicates a newborn in good condition
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7 to 10
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before clamping the cord what must be observed
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presence of two arteries and one vein
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where is the cord clamped
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approx 1/2 to 1 inch from the abdomen
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what can cord blood be used for
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childhood cancers, rare genetic disorders, cerebral palsy
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normal respiratory rate for newborn
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30-60 per minute
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what are indications of imminent birth
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bulging of the perineum; uncontrollable urge to bear down; increased bloody show
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precipitous birth
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occurs when labor and birth occur in 3 hours or less; attending nurse has primary responsibility for providing a physically and psychologically safe experience for woman and baby
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version
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turning the fetus; used to change fetal presentation by abdominal or intrauterine manipulation
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most common type of version
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external cephalic version-fetus is changed from breech to cephalic presentation
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podalic version
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used only with second fetus during a vaginal twin birth and only if twin does not readily descend or if HR is nonreassuring; meds are used to relax uterus; OB draws fetus's feet into cervix
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criteria for external version
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36 or more weeks gestation; NST is reactive; fetal breech is not engaged
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contraindications for external version
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maternal problems; complications of pregnancy; previous c section or other uterine surgery; multiple gestations; nonreassuring FHR; fetal abnormalities or nuchal cord
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amniotomy
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artificial or induced rupture of amniotic membranes
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when is an amniotomy indicated
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induce labor, internal monitoring
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risks of amniotomy
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infection, prolapse of cord, abruptio placentae
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risks of version
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hypoxia, fetal distress, abruptio placentae\
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abruptio placentae
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partial or total premature separation of a normally implanted placenta; emergency
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cervical ripening (induced)
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softening and effacing of the cervix usually with meds
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meds used for cervical ripening
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prostaglandins, misoprostol (Cytotec)
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amnioinfusion
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infusion of warmed sterile NS into uterus through an IUPC
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uses for amnioinfusion
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oligohydamnios, relieve cord compression, dilute meconium stained amniotic fluid
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episiotomy
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surgical incision of the perineal body to enlarge the outlet
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indication for episiotomy
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decrease pressure on fetal head, control direction of extension of the vaginal opening, clean incision easier to repair and heals better
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preventative measures for episiotomies
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perineal massage during pregnancy; natural pushing during labor; side lying position; warm compresses on perineum and firm counterpressure; pushing infant out slowly (breath, push, breath, push)
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what are the indications for forceps assisted births
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presence of any condition that threatens mother or fetus that can be relieved by birth; to shorten second stage; if woman cannot push effectively
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conditions that must be met for forceps assisted births
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complete dilatation; position and status of fetal head known; type of pelvis known; empty maternal bladder; adequate anesthesia; no degree of cephalopelvic disproportion; consent obtained
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risks associated with forceps assisted birth
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vaginal laceration or hematoma; trauma to baby's face or scalp; intracranial or subgaleal hemorrhage
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vacuum assisted birth
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OB procedure used to facilitate birth of fetus by applying suction to the fetal head
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risks associated with vacuum assisted birth
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cephalhematoma, hyperbilirubinemia, intracranial hemorrhage
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cesarean birth
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birth of an infant through an abdominal and uterine incision
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risks associated with cesarean birth
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anesthesia, infection, hemorrhage, trauma to baby
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risks associated with a vaginal birth after cesarean
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hemorrhage, uterine rupture, hyserectomy, infant death, neurological complications
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when is a VBAC contraindicated
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with vertical uterine incision
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